Dr. Tony Zimbardi, PsyD, LMFT

Author of : Forever Dads

Phone Number: (323) 851-1304

E-mail: drtonypsyd@sbcglobal.net

Primary address:
8235 Santa Monica Blvd.
4th Floor
West Hollywood, CA 90046
Alternate address:
11271 Ventura Blvd., #289
Studio City, CA 91604

BODY

These are several articles I’ve written on the importance of taking care of your body in relation to taking care of your mind and spirit. For instance, not taking care of your body through long term substance use/misuse can lead to mental disorders (e.g., Methamphetamine abuse can cause permanent damage to neurotransmitters like Serotonin), depletion of Serotonin can leave one left with clinical depression. Likewise, taking care of one’s body (e.g., regular cardio-vascular activity through exercise) raises endorphins, which gives a natural sense of euphoria and leaves you feeling good about yourself. The condition your body is in, absolutely has an effect on your mental state. Take care of your body and your mind will feel better too.

Click on any of the following titles to read more:

"Psychotherapy: The Mind/Body Connection", Frontiers, Vol. 27, No, 1, copyright May 20, 2008

Psychotherapy: The Mind/Body Connection,
Frontiers, Vol. 27, No, 1, copyright May 20, 2008

By Tony Zimbardi,PsyD

This is the first installment in a two-part series on psychotherapy and the mind-body and mind-spirit connection.  This installment will examine how what we do with; and put into our bodies can aide or abet the psychotherapeutic experience.  Part II will examine the role of spirituality in the therapeutic process.

Much has been written about the mind-body connection, so for the purpose of this article, I’d like to examine the role in which diet, drugs, exercise, yoga and mediation play in your goal to achieve optimal mental health.   Many people may not realize for instance, that depending on your party drug, substance use can lead to mental illness, or conversely, mental illness can lead to substance use.  Likewise, diet can affect the neurotransmitters produced in your brain, affecting your mood states.  Recent research also indicates a strong link in mind-body integration through practices such as yoga and mediation.  So let’s explore these factors and how they may help or hinder your personal therapeutic goals.

Exercise: It is a well established fact that cardio-vascular activity lowers your resting heart-rate and raises endorphins, our natural opiates/feel good chemicals. Exercise actually boosts activity in the brain's frontal lobes and the hippocampus. Studies have found that exercise increases levels of serotonin, dopamine and norepinephrine, more of those natural feel-good chemicals that our brain naturally produces.  Research shows that endorphins do not cross the blood/brain barrier easily, but exercise has proven to be one of the sure routes (J. Briely, “Feel Good After a Workout, Washington Post, 2006). More recently, we’ve read that weight training is an excellent source of cardio vascular activity as well.  This is due to the up and down process of raising and lowering your hear-rate through resting and re-starting “sets” during your work-out

Diet: Did you know caffeine can lead to raising your heart rate, therefore, could invoke an panic attack?  Drug-like foods such as sugars, carbs and alcohol can all trick your brain into thinking it need not produce more neurotransmitters including dopamine and norepinephrine, those natural energizer and mental focusers, GABA (gamma amino butyric acid), our natural sedatives, endorphins, our natural painkillers and serotonin, our natural mood stabilizers and sleep promoters (J. Ross, “The Diet cure”). Your brain also relies on fats and protein, the only food source, which create amino acids, which create those mood-enhancing chemicals.  Be aware, if you happen to be on a low fat or low protein diet, you could also be contributing to your depressed mood.

Drugs: Research shows that cocaine and methamphetamine can lead to anxiety, paranoia, depression, and sleep deprivation.  As a hallucinogenic, it’s possible for ecstasy to bring on a psychotic episode (seeing or hearing things not actually in the environment).  It’s been reported that both can leave the user with longer-term problems with memory and depression (www.thesite.org 2008). So you can see that it’s possible for your substance use to lead to a mental disorder; likewise, for a mental disorder to lead to substance use.  It’s been found that many meth addicts, for instance, are actually treating their undiagnosed ADD (attention deficit disorder); and many individuals experimenting with ‘uppers (like cocaine, speed, meth, etc) are treating, undiagnosed depression.

Yoga: The term Yoga comes from a Sanskrit word, which roughly translates into “union,” referring to the union between the individual and a divine consciousness; the goals in exploring this exercise often include personal transcendence and enlightenment.  As an adjunct to psychotherapy, we might see this practice as mind/body/spirit integration.
Research has shown that brain scans of yoga practitioners show a healthy boost in levels of the neurotransmitter gamma-aminobutyric (GABA) immediately after a one-hour yoga session. Low brain levels of GABA are associated with anxiety and depression (E.J. Mundell, HealthDay Reporter, 2007).  In part, due to the research findings on Yoga, Zenel Segal, professor and Chair of the psychology/psychiatry departments at the University of Toronto has instituted a program called 'mindfulness-based cognitive therapy,' where yoga is used as well as mindfulness meditation as therapeutic tools

Meditation: Meditation can be seen as the complete bridge of the mind/body/spirit integrated approach to self-care.  Meditation can be defined as an engagement of contemplation of a spiritual nature. (M.P. Bhattathiry, Neurophysiology of Meditation 2008).  Mediation lowers the resting heart rate and increases oxygenation to the brain.  Likewise, it brings about that “Zen state” that the Buddhists talk about in terms of accepting the good and the bad with equal grace.  Meditation has been shown to do this by reducing adrenaline and dopamine levels (our natural “speed” chemicals), which in turn reduces the “flight/flight” response.  Yoga has also been shown to reduce levels of serotonin and dopamine, which like any chemical substance, can be too much of a good thing, for instance, research has shown that too much serotonin or dopamine can increase hyper-reactivity and aggression. 

Let me suggest, that in taking an integrative, balanced approach to psychotherapy, via adjunctive mind/body work, you can create a more centeredness or “Zen state,” resulting in more positive outcomes from therapy.  For instance, your therapy combined with the philosophies and physicality of both yoga and/or meditation can help you go from a person who bounces from the extremes of happiness vs. depression, optimism vs. pessimism or self absorption/indulgence vs. self hatred, to someone free of these dichotomies.  If the purpose of psychotherapy is to alleviate human psychological suffering and the purpose of spirituality is to explore questions such as who am I?  What am I?  Why am I here? Then mind/body work can be a bridge to mind/spirit exploration. I’ll conclude with a quote from Arthur J. Deikman, M.D on the topic of psychotherapy and mediation:  “If the therapist engages another human being in an extended therapeutic process, the problem of meaning will eventually arise. Then, the spiritual has much to offer the psychotherapeutic. And what the therapist understands of both will play an important part in the outcome.”  In the next installment of this two-part series, I will explore the role of spirituality in the therapeutic relationship.

 

"Closing The Bedroom Door After The Fallout From An Open Relationship: Born Again Monogamy" - Frontiers Vol. 24 No. 11, copyright October 11, 2005

Closing The Bedroom Door After The Fallout From An Open Relationship:
Born Again Monogamy

Frontiers: October 11, 2005, Vol. 24 No. 11

Some of you may be familiar with the term “Born Again Virgin,” a phrase, adopted by a small segment of the heterosexual population that defines men and women, all of whom had been previously sexually active, who’ve now chosen to “save themselves” for marriage.  Less familiar, may be the smaller, but seemingly growing number of gay male couples who previously had engaged in an open relationship, who are now contemplating re-closing their bedroom doors.  In the seminal book, “The Male Couple,” (McWhirter & Mattison, 1985), the authors present research suggesting that 95% of all gay male couples together longer than 5 years, engage in some form of non-monogamy (anything from “three-ways only” to “don’t ask don’t tell” agreements). So, you may be asking yourself: what’s this “born again monogamy” really all about? And, why would anyone do it?  Well, let’s take a look first at how three couples came to contemplate born gain monogamy again and then I’ll offer some therapeutic tips for those who may be swayed to give it a try.

I’ll call my first couple Ted and Robert, (the names and all identifying information have been changed).  Ted, 58 and Robert, 42 have been together for 8 years, and like many couples, sometime after the two-year mark, noticed that the sex between them really slowed down.  Ted felt it was part of his normal aging process.  Together, they agreed to open their relationship for a period of one-year.  Over time however, Robert began to feel jealous (e.g., “when it’s just the two of us at home, Ted never licks my ass with that much enthusiasm!”) and suggested they return to monogamy at the end of the year.  Ted however, feeling his sexuality was renewed by “variation in partners” didn’t want to go back to monogamy. At that point, the two contacted me and entered couples counseling.

Rahseed and Tom are an interracial couple, both in their early thirties, together six years.  They opened their relationship after 3 years with the agreement of “no second time encounters” with the same guy.  Tom however confessed to Rasheed that he had broken their rule multiple times and had fallen for “Mark.” Tom suggested Rasheed consider allowing Mark to enter their relationship as a third partner.  Rahseed agreed to try this temporarily and quickly became very emotionally attached to Mark as well.  Noticing this attachment, Tom became jealous and insisted that they end their three-person relationship with Mark immediately. All three felt incredibly hurt by the experience and Rasheed and Tom each sought out his own one on one therapist to deal with his private hurt feelings.

Finally, Jose and Ricardo, both 34, came into counseling right after their first anniversary.  They had met at a Circuit party, both under the influence of Crystal, had a whirlwind romance, decided on monogamy and moved in together after one month.  Monogamy lasted until the third month when they were invited to a sex party by their circuit friends. Shortly after, Ricardo was diagnosed with a drug resistant sexually transmitted disease, which ultimately required two rectal surgeries; their sex life died off as a result of the stress. A year later they find themselves emotionally close, but sexually distant.
 
In all three of these scenarios, drama occurred when three couples who started out hoping to enhance their sex lives though an open and honest relationship found that complications such as jealousies, insecurities and a drug resistant STD, can really take a toll on a relationship; all three decided to give monogamy a try once again.  So, if you and your partner are considering closing your bedroom door once more, here are my top five tips: 1) Agree there is a problem: Identify what needs to change, set a trial time period and then check back in with each other.  2) Fully explore your ambivalence: monogamy vs. an open relationship, weigh the pros and cons. 3) Prepare for Born Again Monogamy: Figure out in advance, how you’re going to keep the excitement alive (role-plays, toys, props, etc.) 4) Seek support from other monogamous couples: “It takes a Village!”  5) Normalize a “slip” (someone breaking the agreement).  Agree that all is not lost if it happens; pick yourselves up, dust yourselves off, and start all over again: Rome wasn’t built in a day, behavior change happens slowly and not always easily, don’t be too hard on yourselves.  Allow your relationship to be fluid, get comfortable with the idea of renegotiation. Born Again Monogamy?  It may not be the answer for all couples, but clearly can be a logical consideration.  After all, as a community, we’ve always been the trendsetters; we can’t sit back and let our heterosexual counterparts be the only ones taking daring new risks in the bedroom, now can we?

"Dr. Tony’s Top Five Tips on HIV Self-Disclosure: Rethinking Rejection" - A& U, Issue #79, copyright April 2001

Dr. Tony’s Top Five Tips on HIV Self-Disclosure: Rethinking Rejection

A& U, April 2001, Issue #79
 
By Anthony Zimbardi, PsyD

Show me a person who hasn’t been rejected because of their HIV status at some point in their life and I’ll show you a horse of a different color!  One would have to live in Oz not to on occasion, have experienced the pain of being rejected based solely on their HIV status.  However, there’s a lot to think about here.  Most of us only think about being rejected because we’re positive.  Is there none among us who decided not to date an HIV-negative individual based solely on their HIV status?  Is there anyplace where HIV rejection does not exist in this crazy world? No. Get used to it.  That may sound harsh, but let’s take a few minutes to explore a few issues to normalize your rejection experience.  Follow my top five tips on coping and if and when the rejection occurs, it may take a little of the sting out of it.  It may also give you a little empathy for both yourself and for the person rejecting you.

Tip Number 1: Know Your A, B, C,’s of Self-Disclosure

If you haven’t thought a lot about how you self disclose to different types of people in your life under different circumstances, then how can you begin to be prepared for the possible rejection (or not) that may surprisingly lay ahead?  When dating, decide in advance, at what point you’ll be doing the self-disclosing.    Some people wait until they know they’re going to have sex with their partner.  But how close to the moment when you’re ripping one another’s clothes off are you going to “tell” your secret.  My advise, second date.  Why?  Because there’s no point in doing so on the first date because you don’t know till it’s over if there is even going to be a second date.  By the second date, you’re beginning to size your partner up as “dating material” but have not yet invested emotionally (at least I hope not).

Dating aside, what about your boss?  Your parents?  Your children?  Understand why it’s important to tell this person at this point in your life.  Consider the effect your self-disclosure may have on your parents versus your boss.  Take into consideration the emotional maturity of the person to whom you’re disclosing and be prepared for questions!  When did it happen?  How? With who?  Think about whom this person may tell.  Would keeping things “secret” be an unfair burden on the individual?  And what happens if you don’t tell?  Is missing work for doctor appointments going to get you into trouble?  Or, will “the look” of wasted cheeks (both on your face and your rear end) give you away before you’re ready?   Finally, check in for “peer support” ask your other Poz friends how it was for them to self-disclose.

Tip Number 2: Don’t Ask, Tell!

Although as we’ve just discussed, none of us like to be put in the position of being rejected, put the shoe on the other foot for a moment.  Let’s face it, nobody likes being put in the position where they may be rejected, therefore, take the high road.  Let them reject you, it’s the gentlemanly (or ladylike) thing to do.  In other words, “Don’t Ask, just tell!

Tip Number 3: Life’s Not Fair; Get over it!

Listen, people reject people all the time for all sorts of reasons, sometimes it’s because they remind them of their mother or because they have an irritating laugh, or ugly feet, or a big nose (remember all 500 episodes of Seinfeld?)  If an HIV negative person rejects us based on the fact that we’re positive, it has more to do with their personal fears (e.g.. becoming infected) and perhaps they don’t trust they will always be safe, sexually.  Consider yourself better off, they were not the one for you.  I’m sure since you’ve become HIV infected,  you have rejected somebody, somewhere for some less important reason than HIV status.  Stop personalizing!  Stop magnifying the bad and minimizing the good and get on with your life!   If you don’t, you could miss the one you were really meant to have but lost your chance because you were too busy obsessing over the one that got away!

Tip Number 4: Develop a Positive Identity as an HIV+ Individual

I once had a friend who boasted of his “deeply spiritual life.”  He got up every morning, he prayed, he meditated, he looked in the mirror and recited positive affirmations, and he complained about how lonely and isolated he felt all the time being at home on disability.  I suggested that perhaps he should do some volunteer work at a local AIDS Service Organization if he wanted to have some contact with others.  I was almost decapitated.  He became enraged and started yelling at me: “What about me, I need someone to be concerned about me and my needs, somebody should be taking care of me, I don’t want to be taking care of them!”  Deeply spiritual huh?  Oh yeah, and lonely…and likely to stay that way.  Find ways to give back, it’s a cliché, but you always get back so much more than you give when you volunteer, and guess what, you also get the one thing that only you can give yourself: self-esteem! 

Tip Number 5: Commit!

Commit to living in this world with HIV no matter how crazy it may seem or how many annoying side effects you are experiencing.  Commit yourself to others; a sweetheart, your friends, your co-volunteers.  Develop a support system that will be there for you should you need them.  Commit to helping others do the same if they are at a place in their life where for whatever reason, they just can’t see it happening.  We’ve all had those dark thoughts, where just for a moment, sometimes we think, it may not be worth going on.  Let your light shine for someone else who momentarily is lost in the dark.  And finally, commit to containing this virus within our already existing HIV+ community.

Here’s one idea, if each one of us with HIV committed to only having sex with other people who were also already infected with HIV, it wouldn’t even matter if we used condoms; This disease would stop in it’s tracks.  I realize that in that statement itself I’m asking you to reject your HIV-negative or those of “unknown” HIV status potential partners.  I can’t tell you if I know in my heart whether it’s okay to reject someone based on his or her HIV status or not, whatever it might be; but as mentioned earlier, we reject people every day for far less severe infractions.  What I do know, is that each one of us has the power to change the world; and changing the world always takes risks, it takes leaps of faith, and sometimes, it even takes a little rejection.

 

"Harm Reduction: When Leaving the Party Isn’t an Option" - Pacific Center Journal, Vol. 10, Number 2, copyright Summer 2000

Harm Reduction: When Leaving the Party Isn't an Option
Pacific Center Journal, Vol 10, No 2, Summer 2000

By Anthony J. Zimbardi, Psy.D.


For a very long time now many of us have only looked at substance misuse and it’s management from one perspective, and that was from an “all or nothing” point of view.  From a 12-step perspective for example, there are people in “recovery” and there are “normies,” individuals who are able to stop at just one drink.  In the last decade this paradigm has been re-examined by many in the field of substance misuse treatment and the term “Harm Reduction” emerged looking at substance users from an entirely new perspective.  The “Harm Reduction” movement began during the mid nineteen-eighties in Merseyside, England, and proved successful in both the Netherlands and Australia before being embraced first in this country in Tacoma, Washington.  Summed up in one phrase by Robert W. Westermeyer, Ph.D. in his article Reducing Harm: A Very Good Idea, the goal of Harm Reduction is to meet the substance user “where they’re at.”  What that means is joining the person who “uses” in a way in which you can help him/her to continue to drink alcohol or use drugs, but in a way in which it will cause the least amount of harm to both that individual, and to those around them.

The Merseyside Model (Parry & Newcombe, 1988) conceptualizes harm reduction in the following key principles: A) HIV takes priority over drug prevention and drug treatment. B) Abstinence should not be the only goal of services to drug users because it excludes a large proportion of the people who are committed to long-term drug use.  C) Abstinence should be conceptualized as the final goal in a series of harm reduction objectives, objectives which serve as “safety nets” to protect drug users from serious harm. D) The most effective way of getting people to minimize the harmful effects of their drug use is to provide user-friendly services, which attract them into contact and empower them to change their behavior toward a suitable intermediate objective.

At first, some may find these ideas radical, but when you think about it, Harm Reduction (HR) is a concept that has been around for quite some time.  Probably the one HR expression that most readily comes to mind is the phrase “don’t drink and drive.”  We can easily comprehend that no one is telling us not to drink, as well as reminding us that if we are going to, don’t get behind the wheel of a car where we could possibly harm ourselves, or someone else. 

The entire field of safer sex education is based on Harm Reduction.  For instance, we’re all familiar with education/prevention messages like “if you’re going to have anal sex, use a condom” or if you are going to inject crystal, don’t share needles; if you can’t kick Heroin, try Methadone Maintenance, again, all as a method to reduce the spread of HIV.  We can see now how an idea that may have sounded a bit radical at first (allowing people to use and probably even in some cases abuse substances) is not such a radical concept after all.  Doctor Westermeyer further goes on to pose that the approach to the substance user should not be one such as “Here is what you must do,” but more along the lines of “What can I do to help you?”  We can see that the second approach is a compassionate one which meets the needs of the individual where “they’re at.”  This is a more realistic message for many than a traditional approach to the individual not ready for a treatment facility, an intervention or recovery.  What this approach also creates is an environment where the individual is not only taking responsibility for their substance use, but is possibly taking a first step toward sobriety as well.  Harm Reduction is sometimes the only way to assist an individual unable to move toward sobriety.   There are two things that are important to remember, one is that some individuals whose lives have been traumatized beginning at an early age and continuing upward into adulthood with experiences such as rape, incest, abuse, chronic poverty, homelessness and mental health problems may never be ready for abstinence.  The other important thing to realize is that interventions involving Harm Reduction are not intended to encourage drug or alcohol use or abuse, but simply intended to keep the substance user and those around him/her safe.  And the research supports this theory.  Studies have shown that syringe exchange programs produced little or no measurable increase in IV drug use (Lurie & Reingold, 1993; Waltters, Estilo, Clark, & Lorvick, 1994).

Like Dr. Westermeyer, Catherine Lyons, a nurse practitioner at the San Francisco GENERAL HOSPITAL AIDS CLINIC writes on the topic.  She wrote in her article Competency, “Compliance” & Contracting: Using Harm Reduction to Engage HIV+ Drug Users in Medical Services, “A lot of people hear harm reduction and what they think you’re talking about is giving people what they want. They don’t see it as meeting people where they’re at and working with them.”  She goes on to remind us that “a person’s medical situation is not, first and foremost, their most pressing concern, and that a social worker, outreach worker, drug counselor or friend may be integral in terms of dealing with that person.”

LAMP (Los Angeles Men’s Place) Harm Reduction Multi-Diagnosed Program is a center for adults diagnosed with mental illness which serves Los Angeles’ Skid Row.  LAMP described it’s Harm Reduction model in its’ August 1997 Monthly Newsletter as “accepting people at whatever stage of recovery they are at in any given moment in time.”  And it asks that we “must realize that absolutely anything that helps move a person forward on a continuum of positive and healthy living must be good.”  In another article “Toward a Psychology of Harm Reduction” Robert J. MacCoun of University of California, Berkely discusses the concept of risk “homeostasis” (Wilde, 1982).  In it, we are reminded that “soldiers walk more gingerly when crossing minefields than when crossing wheat fields, and circus performers take fewer chances when practicing without nets” (Hemenway, 1988).  MacCoun concludes that although not every Harm Reduction intervention will be successful, (and some may even aggregate harm), the evidence is encouraging and that we have much to gain by integrating Harm Reduction interventions into our national drug control strategy.

So, if you have a friend, client or loved one not ready or willing to approach abstinence, there are tools available to give that individual.  For instance, ask your crystal-injecting friend(s) if it might not be safer to snort it instead.  If this isn’t possible, give them the location on where to exchange their dirty needles for clean ones.  Share information you hear on the news.  We’ve heard for instance, that the interaction between Viagra and poppers (inhalants) can be deadly (as has been the interaction between the protease inhibitor Norvir (ritonavir) and the “sex/party” drug Ecstasy).  Another tip, let the HIV+ individual know if they smoke a little pot, to “zap” if for a minute in the microwave to kill off fungi (like asperigellis) which can lead to cryptococcal meningitis.  These are definitely only small steps, but these are interventions that if followed, will not only help you to assist someone to cause him/herself less harm, you may even be helping someone to save their life.

"Party Hardy: A Change of Habit" - Pacific Center Journal, Vol. 11, Number 1, copyright Winter 2000
Party Hardy: Ready for a Change of habit?

In the process of assessing and treating ones party habits, before any action can take place it is important to assess where you "are at" in your process and motivation for change. As we all know, it can be frustrating dealing with someone who appears to be unwilling versus unable to address a possible need for change in their substance using habits. We also know that it takes time to make change and many individuals, no matter what the change, are not successful on their first attempt. Drs. J.O. Prochaska and C.C. Di Climente have written extensively about their "Process of Change" model in both The American Psychologist (1992) as well as in Treating Addictive Behaviors: Processes of Change (1986). Based on their research of smokers for instance, they found that the average individual makes four attempts before they are able to quit smoking for good. It is widely known that nicotine is the most addictive substance. The average person entering a treatment facility for drugs/alcohol will go through five rounds of treatment before achieving sobriety. So, it is helpful to look at the application of the process of change model in figuring out how we can address your place in the process in order to assist you or a friend in moving through one stage and into the next toward a lasting change of habit.

The first stage of change in this model is the Precontemplative Stage; during this stage individuals are least interested in altering their substance use. The role of the therapist therefor is to bring attention to the substance user in a way that is non-judgmental, constructive and least likely to bring about defensiveness. Some of the things I do in this first stage is to do some very basic education with the user (e.g. informing him that sharing dirty needles can greatly increase the risk of exposure to HIV and Hepatitis C) while raising doubt and increasing the substance user’s perception of risks and problems associated with the current behavior. Another example of that would be to say something like "I’m wondering if you’re still going to be able to party and maintain your job, you mentioned having gotten a warning for chronic tardiness." I’m brining attention to the matter without judgment. Other variations on the same theme would be if you already had a prior "DWI" (a citation for driving while intoxicated) would be for me or someone who cares about you to inquire into the following line of thought: "I’m wondering if it wouldn’t be better for you not to drive home from parties anymore. Now that you have a DUI, I’d hate to see you get into real trouble. Especially since a second offense is jail time, how about using taxis?" You can see that the questions raise doubt about the individual’s (yours or your friend’s) ability to drive home or hold onto a job; and at the same time, increases the perception of problems associated with the current behavior. Sometimes however, there is nothing anyone can do to help, and the only motivation for moving from the first stage to the second is a court order mandating attendance in therapy or 12-step meetings. Try not to let that happen to you or someone you care about, try to intervene before that point.

Once you or a friend is aware of the problem, one enters the Contemplative stage. According to Arron Beck, et. al in Cognitive Therapy of Substance Abuse (1993), at this stage individuals are willing to examine the problems associated with their substance use, are willing to look at the problem and consider alternatives, although are unlikely to take any concrete steps to change them. During this time you can look at the pros and cons of your substance use and increase your self-advocacy by getting suggestions on where to get information on education, 12 step meetings, etc. During this stage the individual is usually not defensive about their substance use but quite often is still ambivalent: Getting yourself or giving a friend phone number for AA (Alcoholic’s Anonymous) or NA (Narcotics Anonymous) for instance would be one intervention.

The process of change is a lot like the stages of grief and loss (denial, anger, bargaining, depression and acceptance) in the sense that with the process of change for substance users, the process is not always a linear one. In fact they often overlap one another and according to Prochaska and Di Clemente, we can often "get stuck," especially in the earlier stages. Oftentimes when I find myself feeling therapeutically "stuck" with a substance-using client it’s often because I think h/she is in the Action Stage, when actually, they are still in the Precontemplative Stage. In which case, I need to go back and work on increasing their perception and awareness of the problem and raise doubt again in a non-judgmental way regarding their use of substances and the negative consequences of their use. During the Determination or Preparation stage the individual is willing to seek help and makes the commitment to determine the best course of action.

During the next phase, the Action Stage, the individual actually takes these steps toward change. Action can range anywhere from in-patient detoxification or outpatient programs at treatment facilities to community 12-step programs, Rational Recovery meetings or individual psychotherapy. From a Harm Reduction perspective, one simple thing would be to just support the individual in cutting back on the amount of substances they use. Another would be more a more pre-mediated form of support, like assisting them in scheduling changes in current behavior, like arranging to have dinner just before or after a 12-step meeting that they can attend. In Combining Cognitive Behavioral and 12-step Approaches in the Treatment Of Alcohol Dependence, California Therapist, (March/April 1997), Douglas Polcin, Ed.D., suggests that identifying triggers of substance use is the first step. These can be situations or feelings, which trigger thoughts of "using". Another technique is "urge-surfing", where you learn how to tolerate cravings without acting on them. This would include teaching yourself basic relaxation techniques and developing a list of sober friends to call and "talk through" the craving period.

Other things would include avoiding old playmates and playpens, deleting your dealers phone number from your cell and land-line, avoiding "hot spots" like sex-clubs or bathhouses where you frequently got high and put yourself at risk. During this time begin to carry around a laminated phone list in your back pocket of sober people you can call if you’re feeling like you’re having a weak moment and just need to reach out for a little extra support. During the Maintenance Stage you identify and use strategies to prevent relapse. Polcin suggests practicing substance "refusal skills" such as what to say at a party (or in a club) or on a date to refuse drugs and to understand how different situations require different refusal responses.

Beck reminds us that a "Cycle of Addiction" can be created by many factors including low self-esteem, emotional crisis and depression. Beck describes the cycle of addiction as beginning with a low (depressed) mood or anxiety, followed by going out and using substances, which can create financial hard-ship, then social and medical problems which will lead to increased depression and anxiety, to using substances again, to more financial and social problems. Policin suggests that therapeutic options during this period include exploring assertiveness training, anger management and relationship issues. Lastly, it’s important to help yourself renew the process of contemplation, determination and action and knowing when you may be "getting stuck". If relapse should occur, it’s important to normalize the experience as part of the process and remind yourself of the success you achieved during your time of reduced use or sobriety. This way, when you focus on the positive success, you can begin to re-build on past strengths. Relapse warning signs can be indicated by such behaviors as not caring about sobriety anymore; missing therapy or 12-step meetings and letting life’s stressors build up without seeking support. The cycle of addiction is insidious and quite hard to break. Identifying where you or a friend may be in the process of making change may help you or someone you love from spiraling deeper into this cycle and assist in making a positive change in one area of life, which will quite likely translate into positive changes in all areas of life. Good luck!
"Crystal Meth & Sex: What's Love Got to Do With It?" - EDGE, Issue 368, copyright August 20, 1997
CRYSTAL METH & SEX: WHAT’S LOVE GOT TO DO WITH IT?

If you are living in Los Angeles or any other large city for that matter, and consider yourself even a remote member of its vast Gay community, it should come as no surprise to know that methamphetamine (crystal) use is at an all time high. Why now? What is it doing to us, or for us as a community? The use of sex and drugs within the gay community has been synonymous for years. However, historically, we were not so different from the straight community, we went through many of these sex/drug experiences simultaneously. Whether it was Marijuana or LSD in the 60’s and 70’s or cocaine and poppers in the 70’s and 80’s, it seemed at the time, just a part of the sexual revolution regardless of orientation. Now however, literature shows that the gay community is unique in its current association of crystal meth and sex. Why is it that drugs and alcohol have always played such an ever-present role in our gay lives? Psychoanalytic theory has proposed that drug and/or alcohol use was an escape from the pain of unmet needs during the emotional development of the infant. Some works go as far as to suggest alcohol as a psychological substitute for breast milk. Addictions are seen as self-nurturing habits gone haywire. A never ending quest to fill the void left by our care-givers during a time in our lives before we even had words. As adults, we have to deal with even harsher realities than our unmet infantile needs, realities such as homophobia and the AIDS epidemic. Now, we find ourselves as a community suffering a new, unique epidemic which depending on whom you ask, is either destroying or creating a new era within gay culture.

Why now? The easiest answer that most would agree upon, is a reaction of fifteen years of sexual repression and guilt. The heterosexual community has always been fearful of AIDS, but let’s face facts, it has never truly worried that it was at great risk. So gay men are unique in the fact that during a universal sexual revolution specific to the latter part of this century, they are forced into a Victorian mode of "safer" sex activities, monogamy, guilt and a variety of other choices that frankly, many find limiting. During this time a generation has come to be which was raised to equate sex with death. This is contrary to the biological understanding of sex = life that has been understood for thousands of years. Is methamphetamine use an attempt to escape from the pain of this harsh reality, or is it simply a sign that we are evolving as a sexual culture with its own unique set of rituals which will form our new identity? Before looking at what crystal can do for us as individuals and as a community, let’s look at what is has already done for us.

Dr. Cathy Reback recently published a research ethnography commissioned by the AIDS coordinator of the City of Los Angeles to examine the sexual and drug-related behaviors among gay and bisexual methamphetamine users entitled "The Social Construction Of A Gay Drug: Methamphetamine Use Among Gay And Bisexual Males In Los Angeles." This groundbreaking work sheds important light on a gay identity and sub-culture that exists particularly in this region of the United States. Sixty-three individuals participated in the study; twenty-five in one on one interviews; and, thirty-eight in focus groups. Dr. Reback’s study found crystal to be an "equalizer" which allows individuals to cross age, race and socioeconomic boundaries. It is significant that although the interviews were unstructured, all participants involved talked about three distinct core identities: Sexual orientation; Crystal user; and, HIV serio-status. Of the total participants, 50% cited their crystal use as a way to ease the pain of a negative social image as a gay or bisexual male while the other 50% identified as having a very positive self image as gay or bisexual. Individuals frequently cited their crystal use as a means to cope with the fear of HIV and/or free themselves of the responsibility of thinking about HIV. They also frequently cited crystal as a salve to ease emotional pain, boredom, loneliness and grief. Unique to the gay community is the fact that sex is emphasized with crystal use, as opposed to other segments of the population which use the drug for work, weight control and/or mood alteration.

Of Dr. Reback’s participants, 98% knew their HIV status (50% were HIV negative, 50% were HIV positive), and all understood the risks of HIV and unsafe sex. So a startling statistic of the study was that although they knew the risks, 79% of the participants who reported engaging in anal sex indicated only "occasional" condom use. Equally unsettling is the fact that nearly half of her participants (44%) were introduced to crystal by a sexual "partner or lover." As this random study of people without a "recovery" background indicates, 44% of its participants are enhancing their sex partners lives through crystal use.

Psychoanalytic theory aside, most would agree that drugs and alcohol are ways in which we can self-medicate emotional discomfort. Some would say, to escape the pain. If we as a gay society are in so much pain, we must ask ourselves, what are we doing to help cope with our pain. That brings us back to the question, "What’s love got to do with it?" Depending upon how you look at it, everything...and nothing. If love has nothing to do with it, where does love, and love-making fit into our gay lives? We must again ask, aren’t there healthier ways we enhance the lives of the ones we love? Can we rediscover sex itself as an expression of love? Yes we can say that internalized homophobia, the sexual revolution and the capitalist entrepreneurs of gay owned establishments such as bathhouses and sex clubs are partly to blame. But when do we take responsibility as individuals for where we are as a community? More importantly, how can we begin to nurture one another both as individuals and as a community to evolve to a place where we don’t need to use drugs as part of our sexual escape. How can we get back to a place were sex itself is not even an escape, but rather an entry, a pathway to intimacy? Each of us must ask ourselves the answers to these questions, and then each of us must take responsibility for sharing our knowledge, and our love, with others in our lives.

What can you personally do about this epidemic of crystal/sex misuse? Identifying the problem for yourself or a friend is always the first step. And speaking of steps, AA is no longer the only way. 12-step meetings are getting problem specific, whether the problem at hand be compulsive sex, crystal, alcohol or marijuana. There are gay 12-step meetings every night all over Los Angeles. These meetings are a way to build a support system. Everyone needs a support system of healthy people in their lives. If you don’t have one, 12-step meetings are one way to meet people whom you can call when you feel yourself at risk for slipping into an unhealthy encounter of sex or drugs. Another person who can model empathy, create a nurturing environment and assist you in building self esteem would be your therapist, or if you prefer, your clergyperson. These are men and women trained to assist individuals in healing their inner wounds and finding ways to fill the void in their lives. Filling the void in ones life can be as simple as filling ones time, this can mean volunteer work for a cause that is dear to your heart. Other self-nurturing behaviors are hobbies like gardening, learning an instrument or writing. These things not only teach us how to nurture ourselves, they build character. When we are interesting, we attract other interesting people in our lives. When we are loving, we attract other loving individuals, when we give to our community, we ultimately always get back more than we gave.

Let’s all take responsibility for what’s going on in our community. Let’s share our knowledge and express our love. Aren’t these the ingredients from which family is made? Aren’t these the traditions that when passed down through generations create a thriving culture? When we think about sex, and then we think about drugs, we each must ask ourselves the following questions: What does love have to do with it: what role do I want to play in the evolution of gay culture; And, what legacy do I want to leave the next generation? Then we can begin a process of healing.

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